Under bright lights, the audience looks at a bare stage on two planes. Below, a small stage is white and empty, occupied only by a table and two chairs. Above, a huge, slanted mirror reflects a bird’s-eye view of the stage to the audience. Three middle-aged figures enter the stage without looking at each other. One lies down, staring into the mirror. One stands and one sits. For the next 70 minutes, they will never hold one another’s gaze.

This is the revival of Sarah Kane’s play 4.48 Psychosis. The production takes place 25 years after the original work, bringing the original cast and creative team back to the Royal Court where the play was first staged – now transferred to The Other Place, a small theatre run by the Royal Shakespeare Company.

It replicates the staging of the original with precision. The same faces are on the same set, making the same gestures. Even the projections of the street outside show cars from the 1990s. And yet, because this is theatre, there are inevitable differences.

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The play is a revival and a commemoration. Kane wrote 4.48 Psychosis in the year leading up to her death by suicide in 1999 and completed it during her final stay in a psychiatric hospital. It stages the experience of a suicidal and psychotic mind breaking down.

About a week after sending the play to her agent, Kane ended her own life. A year later, the original production was staged at the Royal Court, directed by her long-term collaborator James Macdonald and starring three young actors: Daniel Evans, Madeleine Potter and Jo McInnes. All three have returned for this revival.

4.48 Psychosis is a highly experimental play. It contains dialogue between doctor and patient, poetry, seemingly psychotic speech, lists and quotations from literature and medical documents. In her aims for the play, Kane was both very open and very specific. She described the play in an interview at Royal Holloway University as an attempt to stage the experience of a mind breaking down:

I’m writing a play called 4:48 Psychosis … It’s about a psychotic breakdown and what happens in a person’s mind when the barriers which distinguish between reality and different forms of imagination completely disappear … you no longer know where you stop and the world starts.

What’s more, through an experimental style, Kane hoped to make her audience experience some of the distress experienced by the mental collapse being staged. She described this as “making form and content one”.

How this strange work was to be staged was to be left up to future creatives. She didn’t specify how many actors should perform the work, or provide references to their age or gender. Kane believed that as a playwright, her job was to write the work, and then let directors figure it out.

The result was that the first performance split the experience of breakdown across three actors. At times, they take on more specific roles such as a patient, a doctor, and a lover or bystander. At others, they all seem to occupy a shared mental reverie.

Since the original production, 4.48 Psychosis has been staged in multiple ways around the world. French actor Isabelle Huppert performed the first French production largely as a monologue in 2005, with occasional lines delivered by Gérard Watkins as a psychiatrist. Recently in the UK it has been transformed into a successful opera in which a six-person ensemble and full orchestra performed the play’s “hive mind”, and has been performed in a plastic box in British Sign Language.

When it was first performed in 2000, a year after Kane’s death, the play left a profound impression on its audiences. It was arguably one of the most brutal, head-on representations of mental illness that had ever been seen in British theatre. Reviews from that first production discuss anxieties about whether the play should be viewed as a “suicide note” – a disturbingly “real” reference to Kane’s death.

Today, such anxieties may seem less relevant. After all, over two decades have passed since Kane’s death, and we are in a very different world when it comes to how we view disclosure of personal struggle. In a culture of mental health awareness campaigns and social media oversharing, the closeness of Kane’s suffering to her work seems less scandalous, and perhaps less unsettling.

At times, this revival feels a bit more like a repetition, or archival reconstruction than a fresh performance. There are moments that feel dated – for example, the use of pixelated projections.

The most compelling moments were where something original was introduced due to the more advanced ages of the actors. In my experience, the play is typically performed by a younger cast, as a rageful, energetic cry of despair. It hits differently with a cast in their fifties.

Madeleine Potter’s resigned, ironic complaints about being mistreated by “Dr This and Dr That” gave the impression of a woman with a lifetime’s experience of inadequate mental health services. And Jo McInnes’s desperate monologue about lost love could be referencing an estranged or dead child, as much as a lover.

These moments inserted something new into Kane’s iconic last work and underlined that mental suffering is far from being the privilege of the young. More of a slow burn than an explosive cry of anger, this return to 4.48 Psychosis explores mental torment that can persist over a lifetime, revealing it to be as relevant as ever.

4.48 Psychosis is at The Other Place until July 27.

Leah Sidi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.